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A woman holds her sick baby while waiting for a doctor at Gwoza General Hospital in northeastern Nigeria, August 2017.
AFP/STEFAN HEUNIS

Over the summer, Refugees Deeply took an in-depth look at some of the leading thinkers, ideas and issues related to refugee health.

In “Refugee Mothers: Pregnant in Exile,” a joint series with Women & Girls, our reporters examined how health systems provide maternal healthcare for refugees in different contexts, from an emergency such as South Sudan to the protracted Afghan refugee situation.

Tania Karas reported from Lebanon on why, despite relatively advanced healthcare, pregnancy and childbirth are fraught with danger and unaffordable costs for Syrians.

“Clearly, cost is the number one, two, and three reason refugees can’t access healthcare,” said Dr. Michael Woodman, the UNHCR’s senior public health officer in Lebanon … The UNHCR paid $50 million into the Lebanese healthcare system last year. It’s the biggest health budget in the organization’s history, Woodman said, due to Lebanon’s high cost of care. “It’s totally unsustainable,” he added.

Amy Fallon reported from Uganda about women giving birth in the world’s largest refugee camp, where maternal mortality is low relative to South Sudan, where the women have escaped from.

In another zone of Bidi Bidi, Betty Juan, 18, who fled South Sudan in May 2016 with her two children, gave birth in a health center operated by Medecins Sans Frontieres (MSF) in early July. When she fled South Sudan, leaving her husband behind, she was one month pregnant. “In South Sudan the labor pain can take long, but this time it didn’t,” she said.

One aid worker in Tehran who did not want her name published said that undocumented Afghans are scared to go to hospitals. Even pregnant women are technically liable for deportation if they don’t have documents. “Those without registration are afraid that accessing medical services may have repercussions with the government,” the aid worker said.

Like many others in the camp, my mother fell ill. She continued to be ill with various sicknesses for the majority of the time we were in Nairobi. I became the caregiver for both her and my younger brother.

Dr. Ibrahim al-Masri, a Syrian doctor now resettled in Canada, tells his story of fighting for the rights and health of refugees in Lebanon.

I tried to work as a volunteer at a Lebanese hospital, but they told me I needed a medical license, which was prohibitively expensive, and a work permit, which the labor ministry refused to give me. Some Syrian refugee activists had a better proposal – there are so many refugees in Lebanon without any medical services, why didn’t I help them?

What should, under Greek law, be a medical determination of Mohamed’s mental and physical condition has become subject to politics. Many asylum seekers who meet the criteria of vulnerability – including victims of torture and people with less obvious disabilities – are being confined to the islands, according to medical charities Medecins Sans Frontieres (MSF) and Doctors of the World (MdM).

In a country with a struggling health service as a result of years of austerity, and as donors move away from emergency funding for asylum seekers and refugees, this is an important time to focus on strengthening the Greek health system. Integrating asylum seekers and refugees into the public health system can serve as a platform to strengthen these services in general, benefiting asylum seekers, refugees and the host community, and leading to more equitable and inclusive healthcare.

Capsaskis was among the leading thinkers and practitioners profiled in our Experts to Watch on Refugee Health. Another was Paul Spiegel, director of the Johns Hopkins Center for Humanitarian Health and formerly of UNHCR, who proposed four ways to fix the humanitarian system’s failings on refugee health in this excerpt from the Lancet.

The establishment of parallel healthcare systems should be avoided except when existing systems cannot be quickly capacitated to respond or when humanitarian principles such as humanity, neutrality, impartiality and independence cannot be maintained.

We also looked at the particular health challenges faced by refugees with disabilities. Natalie Sikorski talked to Human Rights Watch’s Jonathan Pedneault in South Sudan, where decades of war have left high numbers of people with disabilities, many unable to flee violence or access aid.

It’s unfortunate that you still find a large number of latrines and showers that are not adapted for people with disabilities in the [U.N. Protection of Civilians] PoCs, or bridges that are not leveled or are destroyed, which means that people in wheelchairs are facing a lot of challenges just to get around the camp.

No population understands entrenched stigma and discrimination better than people with intellectual disabilities … These vulnerabilities become even more acute for migrants and refugees with intellectual disabilities.

Amid debates over healthcare reform and Medicaid in the U.S., Anna Lamb talked to P.J. Parmar, the founder of a clinic for refugees in Colorado, about his effort to provide an alternative for-profit model for refugee health services in the U.S.

The stigma that prevents a lot of providers from taking Medicaid patients – and refugees especially … If you can get over those concepts, and create a system actually tailored to the clients in a patient-centered system rather than tailoring it to the funding source or to the comfort of the providers, then I think you could serve patients very well pretty much anywhere in the world.

About the Author

Charlotte Alfred is managing editor of Refugees Deeply. Previously, she was a reporter for The Huffington Post focused on Africa, worked on documentaries for PBS Frontline and was English editor at Ma’an News Agency in the West Bank.

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